ROCKFORD — Micah is a chubby 8-month-old boy with wild hair and a wide smile.

He lives in public housing, where he is loved and cared for by his mom, Leah Shackleford, 34.

Two years ago, Shackleford couldn’t care for herself, much less her four children.

Had Micah been born before his mother shook addiction, his demeanor and future already may have been poisoned by toxic stress — chronic tension brought on by abuse, neglect, neighborhood violence, the substance abuse or mental illness of a caregiver, or poverty. It can result in a litany of learning, social and health problems that follow children into adulthood.

While some stress is normal, prolonged stress causes increased heart rate, higher blood pressure and the release of stress hormones such as cortisol. That puts a child into a constant state of high alert, like a motor with a stuck accelerator.

Toxic stress during early childhood can rewire a developing brain and change DNA. And it’s much more likely to affect children who grow up poor.

“The most significant predictor of toxic stress and trauma is poverty,” said Juanona Brewster, director of early childhood development for the Illinois chapter of the American Academy of Pediatricians. “It surprises a lot of people, but that is what the research says.”

The number of neglected and abused children in Winnebago County is double the state average. The Illinois Kids Count 2014 survey found that for every 1,000 children in the county, 18.6 were abused between 2011 and 2013. In Illinois, the rate was 8.6, said Chicago-based Voices for Illinois Children, a nonpartisan advocacy organization.

Nature, nurture or both

Before they’re out of diapers, a child suffering from toxic stress already may face a life of social problems and health issues. Raised poor by detached parents, these children may never escape the limitations of an unhealthy upbringing and remain at the bottom of the economic ladder.

“The age-old question has always been nature versus nurture,” said Dr. Steven Schulz, a pediatrician with Crusader Community Health in Belvidere.

“Well, the correct answer is both.”

Harvard University’s Center on the Developing Child says toxic stress can result in damaged, weakened systems and altered brain architecture in children. That can mean lifelong repercussions such as trouble learning, behavioral problems and health issues.

Searching for answers

Doctors and public health officials have worked to develop new strategies to identify and intervene in families at risk of toxic stress since 2012, when the Journal of the American Academy of Pediatrics defined the condition, which has implications not only for individuals but also for the communities in which they live.

“It increases risk for aberrant behavior that is not tolerated by other social groups,” said Mike Bacon, administrator of the Winnebago County Health Department. “It’s real easy then for them to slip into a cycle of crime and violence. It’s difficult for them to grow into healthy habits, to hold a gainful job. If we don’t have that, we’re unable to support a family.”

Bacon said developing children who suffer toxic stress also are more likely to develop high blood pressure, high cholesterol, obesity, Type 2 diabetes, cardiovascular trouble and cancer.

Mom returns

That’s not the future Shackleford wanted for her children. But her addiction left her unable to do anything about it.

“My kids were here, but they weren’t a part of my life,” she said.

With her drug addiction consuming her, the Illinois Department of Children and Family Services gave the single mother a choice: seek treatment or lose her children.

She entered treatment in 2011, first in Chicago for 90 days and then for nine months through the Rockford Rescue Mission Women’s Life Recovery Program. She stayed at the Rescue Mission for 20 months. Her children were in DCFS care, living with Shackleford’s mother.

Shackleford said that treatment “worked me back into being a mom.”

She regained custody of her children in January.

On the front

There are ways to counter toxic stress, but it must be diagnosed first.

Pediatricians like Schulz are on the front line in screening for it. The American Academy of Pediatrics asked doctors to use age-appropriate, standardized tools to identify risk factors.

They should evaluate children for developmental delays, learning disabilities and behavior problems. And they need to look for family or community factors that put children at risk, including maternal depression, abuse, domestic violence in the home and food scarcity.

“It helps bring up issues for referrals and evaluations earlier,” Schulz said. “It allows you as a physician to intervene into an issue that would not have come out without these screening tools.”

Schulz said early intervention is key.

“The times when a lot of these interventions are most important is the early years because there is growth and development,” he said. “You’re setting building blocks at an early age. If changes are made and interventions are made, it certainly is going to halt progression.”

Halting progression means helping mothers and fathers learn how to parent, and finding ways to deal with the socioeconomic stress behind the condition. In older children and adults, Schulz said, counseling and other services provided by schools and partner agencies can help.

“The earlier you intervene, the better the outcomes you have,” Schulz said.

Working with families

When a child suffering from or at risk of toxic stress is identified, counseling may be prescribed through the collaborative of the Maternal Infant and Early Childhood Home Visiting Program.

The health department-led collaborative has trained employees from Easter Seals, Head Start, the Rockford School District and La Voz Latina. They visit families, helping adults become nurturing parents by building responsive relationships with their children. That lowers stress in the lives of their kids.

“Secure attachment is a complex theory, but it’s easy to show clients how to do it,” said Lisa Gonzalez, the health department’s family health services director.

“A lot of what we’ve done at the health department about this early attachment idea is to really just talk about developing a positive bond by holding your baby, feeding your baby while you’re holding them, playing with them, reading and talking to them.”

Once a week, Melissa Johnson visits Shackleford and her children at their Orton Keyes apartment.

Shackleford, a single mother, has three of her four children living with her — Micah, Makenzie, 2, and Madison, 8. Her son Mason, 11, lives in Oklahoma.

Johnson, an Early Head Start home visiting teacher, spends 90 minutes a week at their apartment, the first time Shackleford has had her own place.

During a visit last month, Micah worked on stretching and fine motor skills. Makenzie worked on colors and shape-sorting. They all sat on the floor and sang songs together as a family, something Shackleford was close to never experiencing.

Since becoming sober, Shackleford has earned a GED and gotten a driver’s license.

Her work toward sobriety and reclaiming her family has been noticed. Shackleford traveled to Springfield this weekend to be honored by the Illinois Association of Community Action Agencies for its Family of Distinction Award.

“I’m so excited about Springfield,” Shackleford said. “We’re going to stay at The Hilton.”

Shackleford also is excited that her daughter, Madison, got an award, too, as most-improved student at Nashold Elementary School. Her grades improved as Shackleford learned how to be a mother.

“Now, I just want to be a good mom,” she said. “I want tradition. I want stability. I want roots. I want my kids to be independent, smart, strong, strong in their faith.”

Brian Leaf: 815-987-1343; bleaf@rrstar.com; @b_leaf

About this series

Poor Town is an occasional series on the effects of poverty in the Rockford Region. In Winnebago and Boone counties, the number of people living in poverty doubled from 29,152 to 60,544 between 2000 and 2010, according to Census figures. In Rockford, the number of poor quadrupled, leaving nearly one in four adults and 37 percent of children surviving on incomes below the poverty line.